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Thrombomodulin as a Marker for Bleeding Complications During Warfarin Treatment

Lind, Marcus; Boman, Kurt; Johansson, Lars; Nilsson, Torbjorn K.; Öhlin, Ann-Kristin LU ; Birgander, Lisbeth Slunga and Jansson, Jan-Hakan (2009) In Archives of Internal Medicine 169(13). p.1210-1215
Abstract
Background: The major adverse effect of warfarin treatment is hemorrhage. Several risk factors for bleeding complications are also risk factors for thromboembolic events, making the clinical decision to initiate or withhold anticoagulant treatment difficult. Specific markers that solely identify patients at high risk of bleeding would have great clinical impact. This study aimed to test if thrombomodulin (TM) concentrations were associated with bleeding complications, cardiovascular events, or mortality in long-term anticoagulant-treated patients. Methods: In a longitudinal cohort study we followed up 719 patients receiving warfarin treatment for a mean duration of 4.2 years. All bleeding complications causing hospitalization were... (More)
Background: The major adverse effect of warfarin treatment is hemorrhage. Several risk factors for bleeding complications are also risk factors for thromboembolic events, making the clinical decision to initiate or withhold anticoagulant treatment difficult. Specific markers that solely identify patients at high risk of bleeding would have great clinical impact. This study aimed to test if thrombomodulin (TM) concentrations were associated with bleeding complications, cardiovascular events, or mortality in long-term anticoagulant-treated patients. Methods: In a longitudinal cohort study we followed up 719 patients receiving warfarin treatment for a mean duration of 4.2 years. All bleeding complications causing hospitalization were registered and classified. Soluble TM antigen (sTM) concentration in plasma was measured with an enzyme-linked immunosorbent assay method. Results: During the follow-up time, 113 clinically relevant bleeding events and 73 major bleeding events occurred. Increased concentration of sTM was associated with both clinically relevant bleeding and major bleeding events after adjustment for age. In the multivariable models, hazard ratios for the highest tertiles; compared with the lowest were 2.29 (95% confidence interval, 1.35-3.89) and 2.33 (95% confidence interval, 1.21-4.48), respectively. No association between sTM concentration and nonfatal ischemic cardiovascular events or all-cause mortality was found. Conclusions: Increased levels of sTM are associated with bleeding complications during warfarin treatment but not with cardiovascular events or all-cause mortality. Soluble TM antigen concentration has potential as a new specific marker to identify patients at high risk of bleeding during warfarin treatment. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Archives of Internal Medicine
volume
169
issue
13
pages
1210 - 1215
publisher
American Medical Association
external identifiers
  • wos:000268188900009
  • scopus:67650463006
ISSN
0003-9926
language
English
LU publication?
yes
id
7bd28080-0656-4af0-8e0e-9a1f8d467898 (old id 1461873)
date added to LUP
2009-08-31 10:58:56
date last changed
2017-01-01 04:20:55
@article{7bd28080-0656-4af0-8e0e-9a1f8d467898,
  abstract     = {Background: The major adverse effect of warfarin treatment is hemorrhage. Several risk factors for bleeding complications are also risk factors for thromboembolic events, making the clinical decision to initiate or withhold anticoagulant treatment difficult. Specific markers that solely identify patients at high risk of bleeding would have great clinical impact. This study aimed to test if thrombomodulin (TM) concentrations were associated with bleeding complications, cardiovascular events, or mortality in long-term anticoagulant-treated patients. Methods: In a longitudinal cohort study we followed up 719 patients receiving warfarin treatment for a mean duration of 4.2 years. All bleeding complications causing hospitalization were registered and classified. Soluble TM antigen (sTM) concentration in plasma was measured with an enzyme-linked immunosorbent assay method. Results: During the follow-up time, 113 clinically relevant bleeding events and 73 major bleeding events occurred. Increased concentration of sTM was associated with both clinically relevant bleeding and major bleeding events after adjustment for age. In the multivariable models, hazard ratios for the highest tertiles; compared with the lowest were 2.29 (95% confidence interval, 1.35-3.89) and 2.33 (95% confidence interval, 1.21-4.48), respectively. No association between sTM concentration and nonfatal ischemic cardiovascular events or all-cause mortality was found. Conclusions: Increased levels of sTM are associated with bleeding complications during warfarin treatment but not with cardiovascular events or all-cause mortality. Soluble TM antigen concentration has potential as a new specific marker to identify patients at high risk of bleeding during warfarin treatment.},
  author       = {Lind, Marcus and Boman, Kurt and Johansson, Lars and Nilsson, Torbjorn K. and Öhlin, Ann-Kristin and Birgander, Lisbeth Slunga and Jansson, Jan-Hakan},
  issn         = {0003-9926},
  language     = {eng},
  number       = {13},
  pages        = {1210--1215},
  publisher    = {American Medical Association},
  series       = {Archives of Internal Medicine},
  title        = {Thrombomodulin as a Marker for Bleeding Complications During Warfarin Treatment},
  volume       = {169},
  year         = {2009},
}